Opioid and other substance abuse disorders affected about 12 percent of all Medicaid beneficiaries in 2015 (Mark, Lubran, McCance-Katz, Chalk, & Richardson, 2015). Patients who overdose on opioids are more likely to survive if the drugs they need to counteract the overdose are included as part of their Medicaid drug benefit (Mark et al., 2015).

Emergency medical personnel traditionally treat opioid overdoses. But Medicaid can also provide lifesaving drugs like naloxone as a preemptive measure. This involves making opioid overdose medications, such as naloxone, available through nontraditional settings like pharmacies and mental health clinics where beneficiaries can have immediate, non-emergency access.

Medicaid’s Role in Providing Nontraditional Access to Opioid Overdose Drugs

We’ve all heard of the high costs of drug treatments, but you probably don’t know that a full year of treatment with one of the approved opioid abuse medications can cost as much as $6,000 (Wen, Hockenberry, Borders, & Druss, 2017). Because of the high cost of opioid overdose treatments and the need to get those treatments closer and faster to patients in distress, Medicaid has become important to the nontraditional distribution of naloxone.

Medicaid plays a critical role in expanding access to drugs like naloxone that are needed to combat our nation’s opioid epidemic (Morton et al., 2017). One strategy is to use pharmacies to dispense naloxone as part of a “standing order” prescription. As illustrated in Figure 1, pharmacies provide an efficient means to successfully distribute naloxone to anyone who needs it under the standing order. Having Medicaid pay for the drug provides an “effective avenue for naloxone acquisition”(Morton et al., 2017). Many standing order programs are designed to distribute naloxone to community members who may have family members who are susceptible to opioid overdoses.

Nontraditional Distribution of Naloxone

Implementing nontraditional naloxone distribution programs requires cities and states to enact ordinances, pass legislation, or issue policies. Baltimore, for example, has a standing order that allows pharmacies to distribute naloxone to anyone with the proper training. The “Baltimore Staying Alive” program enables authorized entities to train and certify community members to identify opioid overdoses and to safely administer naloxone (Behrle, 2015). Since 2004, the program has educated more than 17,500 injection drug users, drug treatment clients and providers, inmates, and corrections officers on how to prevent overdoses. The program is credited with saving at least 230 lives (Behrle, 2015).

In New Mexico, a program has provided pharmacists with authority to prescribe and distribute naloxone. Within the first two quarters of 2016, 100 pharmacies filed 808 Medicaid claims for naloxone pharmacies, compared to 87 such claims by 33 pharmacies in all of 2014, which was the program’s first year (Morton et al., 2017).

What Can We Do?

One of the barriers to naloxone distribution programs is government’s limited ability to evaluate the drug’s distribution, use, and impact (Morton et al., 2017). At StrategicHealthSolutions, LLC (Strategic), we are in the unique position to help understand the success of naloxone distribution programs and provide medical reviews and suggestions to help improve them. Other areas of potential support include producing educational materials on the proper use and application of naloxone. By increasing the capacity to distribute naloxone in nontraditional ways, Strategic can help redefine health care as a sustainable resource and protect the future of health care for generations to come. #RedefineHealthCare

About the Authors

Scott Stocking

Scott Stocking is a certified Prior Learning Assessor with 25 years of experience. He has a Bachelor’s degree in Psychology and a Master of Divinity. He specializes in educating adult nontraditional learners and developing continuing professional educational materials. At Strategic, he is a Health Care Program Subject Matter Expert with a focus on Medicaid program integrity and Medicare provider education.

Stuart Rabinowitz

Stuart Rabinowitz, MBA, MSHI is the Division Director of IT & Data Analysis for Strategic. Stuart holds an undergraduate degree from Temple University, an MBA from Lehigh University, and a Master’s of Science in Health Informatics from the University of Illinois at Chicago.

Ira Nathan

Ira Nathan, ASA, MAAA is an Analytics Manager for Strategic. Ira holds an undergraduate degree from the University of Nebraska. He is an Associate in the Society of Actuaries and a member of the American Academy of Actuaries.